2.3. HIV PREMARITAL COUNSELING AND TESTING (PCT)
4.1.4. 2.3.1. DEFINITION
HIV premarital counseling and testing is a specific form of
HIV VCT by which an individual who is about to enter into marriage undergoes
counseling enabling him/her to make an informed choice about being tested for
HIV in order to be able to make informed, right and responsible decision about
marriage and production of offspring. However, some countries classify HIV PCT
as a mandatory HIV testing rather than voluntary.10,35,42,45
4.1.5. 2.3.2. JUSTIFICATION OF PREMARITAL EXAMINATION
Why is pre-marital examination
important?
Many people are not aware of their state of
health. An individual might look healthy but he may be a silent carrier to
potentially contagious infections or serious hereditary disorders. A routine
medical test will reveal such conditions so that necessary precautions or
course of treatment could be initiated to avoid affecting the partner or
passing on the disease to the next generation. Therefore premarital screening
is important since it allows would-be couples to assess their own general
health status, maintain good physical health for a 'happily ever after'
marriage and strengthens the marriage relationship.14,15,27,46
With advancements in medicine engineering opening up new
possibilities of medical screening - and with the fear of the spread of
diseases like STIs including HIV-AIDS - there is considerable pressure to
require prospective spouses to undergo pre-marital medical exams. Thus some
countries, like France, China, Syria, Tunisia, Egypt, Morocco, Saudi Arabia,
the United Arab Emirates (UAE), among others, have encouraged their citizens to
go for such pre-medical exams. Some have even made doing so a legal mandatory
requirement for marriage that allows not only informed, right and responsible
decision about marriage but also the control of targeted diseases and health
related problems in new couples.10,14,15
Furthermore, the marriage contract is a serious commitment
that is supposed to be permanent and stable. If it surfaces after marriage that
one of the spouses has a serious disease, this could lead to a premature
termination of the marriage (divorce) if the other party refuses to stay with
the person on account of the illness.14,15
Finally research has shown that there is higher level of
marital satisfaction and stability among couples who attended a satisfactory
premarital counseling and testing than those who did not.46
4.1.6. 2.3.3. HIV PCT PACKAGE 10
Like in all VCT service, counseling plays a significant role
in HIV premarital examinations. Therefore classic HIV PCT service package
ensures that:
a. Knowledge of status is
voluntary;
b. Pre-test counseling is offered
either through one or more sessions with a doctor or trained counselor, after
which the engaged individuals may choose to test on the same or different
day;
c. Informed consent is obtained from
the engaged person by a service provider; couple counseling for VCT is valuable
intervention when truly voluntary and when there is adequate informed consent
by both parties10.
d. Interrogation and physical examination of
client is performed by the physician in a serene atmosphere;
e. HIV test (and other required
laboratory tests) is ( are) performed using approved tests and testing
protocols;
f. Disclosure of test results and Post test
counseling: one or more sessions held for informing client of
his/her test results may take place on the same or different day after adequate
post test counseling. The physician/counselor must disclose the results to the
concerned person.6,47 The responsibility of the physician/counselor
is to warn would-be couples on eventual consequences of a positive HIV test
result he discovered and on possible preventive measures to limit the spread of
the infection. He may not disclose the result to the partner, unless the owner
of the result gives prior permission. In any case the physician/counselor
should not refuse to disclose the results and to deliver the prenuptial medical
certificate to the client.6,47
In certain part of the world, doctor can even recommend
against marriage and let the couple decide on the
recommendation.10,13
The essential thing is that if a fiancé(e) is found HIV
seropositive, he will be informed by a medical counselor on the dangers facing
the couple and the expected offspring so that (s)he makes responsible and
informed decision about marriage. The physician/counselor shall also inform
both parties to the intended marriage of the nature of the disease, the
possibilities of transmitting such infection to his or her marital partner or
to their children and the possible available preventive actions (e.g. protected
sex by condom, mutual faithfulness, PMTCT...) to be applied for life if they
still wish to marry. The couple, or each fiancé at least, then decides
freely and knowingly whether they go ahead with the marriage, regardless of the
results or break the marriage project. 48,49
g. Deliverance of prenuptial medical certificate (marriage
license) to the client after post test counseling, document that is required
for the publication and the celebration of marriage.3,5
HIV PCT without pre- and post-test counseling should not be
recommended.
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